| NPI | 1124694419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0017626) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 0017626) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2021-08-19 |